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If you haven't already heard about something called the microbiome, you probably will soon. The human microbiome has become one of the hottest areas of medical research, and findings could lead to a revolution in human health. For people with inflammatory bowel disease (IBD), the research could hold the key to future treatment and even prevention.

“The human microbiome is all the microbes that normally live inside the human digestive system," said Keith Sultan, MD, an assistant professor at Hofstra North Shore-LIJ School of Medicine and a gastroenterologist at North Shore University Hospital in Manhasset, N.Y. "For doctors who treat IBD, the big interest is in bacteria that live inside the colon and small intestine. These bacteria may be the key to controlling IBD."

Everyone has trillions of microbes living inside their digestive tract. These microbes, collectively known as the microbiome, help the body digest food, produce vitamins, prevent digestive tract infections, and control the immune system. Research is showing that a healthy balance of these microbes is essential for maintaining good health.

When the balance of the microbiome gets upset, it is called dysbiosis. Researchers believe that dysbiosis may be the trigger for IBDs, such as Crohn’s disease and ulcerative colitis. Preventing dysbiosis, then, could be the key to controlling IBD, which is thought to affect more than a million Americans.

About the Microbiome

A 2013 review of microbiome research, published in the journal Genome Medicine, reported that the human microbiome plays a major and lifelong role in maintaining health. Bacteria in the microbiome have been closely linked to many autoimmune and inflammatory diseases, including IBD. Profiling the microbiome through the study of microbial genes is the next step in moving toward new treatments, according to the review.

At a symposium on the microbiome, sponsored in 2012 by the American Association for the Advancement of Science, researchers noted that the discovery of the 4 million or more genes in the microbiome is one of the hottest areas of scientific research. They predicted that this research may lead to a revolution in treatment of infections, malnutrition, diabetes, obesity, and IBD.

“We suspected that the microbiome was important in the past, but the only way we had to learn about it was to do bacterial cultures," said Dr. Sultan. "That’s not very useful in an area that is teeming with bacteria. The big leap was the ability to do gene sequencing for all the different bacteria within the microbiome.”

The Microbiome in IBD

“Current thinking is that people with IBD inherit genes that predispose them to the disease," Sultan said. "Not everybody with the genes gets the disease. Something in the environment has to trigger the genes to cause disease. Increasingly, it looks like bacteria in the microbiome are a major trigger."

Studies have shown that people with IBD tend to have dysbiosis, with less of the friendly bacteria and more types of bacteria that cause gut inflammation. But whether IBD causes the dysbiosis that leads to gut inflammation or whether dysbiosis triggers IBD is one of the big questions that remains to be answered. “It’s a classic chicken-or-egg situation,” Sultan said.

The Crohn’s & Colitis Foundation of America is sponsoring research to help understand the role that the microbiome plays in IBD, called the Microbiome Initiative. Since starting in 2008, researchers have completed collection of DNA data from the microbiomes of people without IBD and are now collecting data from the microbiomes of people with IBD. They hope to identify changes in the microbiome that occur during IBD flares and remissions.

“The dream scenario would be that we discover which bacteria trigger IBD and eliminate them," Sultan said. "That could cure IBD." But he said that a more complicated relationship is more likely. “The links between the microbiome and IBD are probably part of the puzzle," he said. "What we learn may allow us to customize treatment for each patient with IBD based on their own genes and the genes of their microbiome."

It's already known that people can inherit 169 genes that may predispose them to having IBD. And it's known that bacteria inside the digestive tracts of people with IBD are different from bacteria of people without IBD. Now experts have to start putting the puzzle together.

“There is a lot of time and a lot of money being spent on profiling the microbiome," Sultan said. "There is too much going on for there not to be some big breakthroughs in the near future."